Addressing Childhood Trauma: Optimizing Use of the National Survey of Children’s Health January 25, 2017 PM 2:30-4:00PM ET Christina Bethell, PhD, MBA, MPH Johns Hopkins Bloomberg School of Public Health Child and Adolescent Health Measurement Initiative Department of Population, Family and Reproductive Health

For Child & Family Health (using family centered data and tools) Identify Shared Transformative Goals For Child & Family Health Promote Early and Lifelong Health of Children, Youth and Families (using family centered data and tools) Transformational Partnerships Actionable Data & Data-Driven Tools Inspire and Inform Bethell, C 2016

Promoting early and lifelong health leveraging prevention and human development sciences. A Critical Goal: Optimize the capacity of Medicaid to drive and ensure efforts at the individual, family, community and systems levels to effectively address social and emotional determinants of health, like ACEs, to promote positive health resilience and well-being among children, youth and families. ….and catalyze and epidemic of health for generations to come!

Hard Science Reveals Requirements for Healthy Development and Well-Being Positive Health, Resilience, Protective Factors and Risks Social and Emotional Development Safe, Stable, Nurturing Relationships If regulation requires connection—what does “self-regulation” mean? Source: Bethell, C 2016

ACEs Impact Multiple Outcomes General Health and Social Functioning Relationship Problems Married to an Alcoholic Poor Self-Rated Health Smoking Alcoholism High perceived stress Difficulty in job performance Hallucinations Promiscuity High Perceived Risk of HIV Depression Obesity General Health and Social Functioning Sleep Disturbances Risk Factors for Common Diseases Mental Health Memory Disturbances Poor Perceived Health ACEs Illicit Drugs Anxiety IV Drugs Panic Reactions 5 categories are… Examples of these categories are… But wait, there’s more… It is easy to look at this slide and to be overwhelmed, but I see potential because if all of these diverse outcomes are associated with ACEs, there’s at least the potential to impact upon all of these public health crises by preventing and addressing childhood toxic stress. Another way to breakdown this slide is to look at these 6 risk factors, which are essentially unhealthy lifestyles that are known to be maladaptive stress reduction techniques. THEY ARE ALL WAYS TO ESCAPE, even if only temporarily, THE STRESS OF LIFE. And most of the rest of these adverse outcomes can be attributed, at least in part, to these unhealthy lifestyles. So, this forces us to look at adolescent and adult health in a completely different manner. Are we going to continue treating all of these unhealthy lifestyles and symptoms of unmanaged stress, or are we going to pro-actively address the childhood antecedents – the root or distal causes? Which reminds me of the following public health parable… Prevalent Diseases Sexual Health Multiple Somatic Symptoms Poor Anger Control Cancer Liver Disease Teen Paternity Fetal Death Skeletal Fractures Chronic Lung Disease Teen Pregnancy Unintended Pregnancy Sexually Transmitted Diseases Early Age of First Intercourse Ischemic Heart Disease Sexual Dissatisfaction 5

Data Resource Center

Prevalence Among US Children (2011-12 National Survey of Children’s Health) Prevalence of 2+ (of 9) ACES: 16.3% (UT) – 32.9% (OK) Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016 Source: Bethell, C 2016

Source: Bethell, C 2016

Impacts on chronic condition status appear early in life. Bethell, C, Newacheck, P, Hawes, E, Halfon, N. Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. (2014) Health Affairs Dec; 33(12);210-2016 Source: Bethell, C 2016

Prevalence and Adjusted Odds Ratio of EMB Conditions, by ACEs Status and Age, Data: 2011-12 NSCH

Equally Unequal: Similarities of Impact Across Income Groups Prevalence of Emotional, Behavioral of Developmental Problems Among Children with 4+ ACEs: By Household Income Rich or poor The withholding of love Pierces May you be led to the mysterious transfiguration this piercing can allow And open to the truth from within like the nautilus closing off all former layers And slowly, patiently rising up into the love that always was Mirrored or not Always was Always will be Excerpt from “Breaking Ground” Christina Bethell Bethell, C 2016

Nearly 2/3 of children with public sector insurance coverage carry ACEs, such as physical and emotional abuse and neglect, substance abuse or mental illness in the home, justice-involved family members, exposure to violence, and extreme poverty. 63.8% Public. 36.6% Private. 58.4% Uninsured

Maternal Health and Child Health

School Engagement Rate Among Children With Special Health Care Needs Exposed to 2+ Adverse Childhood Experiences: By Demonstration of Resilience “You can go good places with your mind if you can’t go good places with your body. “ Stephen Porges, PhD Professor Emeritus, University of Illinois at Chicago. Director, Brain Body Center in the Department of Psychiatry. Author: The Polyvagal Theory Bethell, C 2016

Child Protective Factors Prevalence of School Success Factors Among US Children Age 6 to 17 with EMB Conditions and 2 + ACEs by Resilience Status. Data: 2011-2012 NSCH

Flourishing and Adverse Childhood Experiences (US Children Age 6-17)

Flourishing and ACEs (2+) Among School Age Chidlren 44% CA to 25 Flourishing and ACEs (2+) Among School Age Chidlren 44% CA to 25.8 NY Zero ACEs: 62.9% ND to 44.7% DC

Public vs. Privately Insured Children Higher ACEs, Similar Across State Variation (www.childhealthdata.org)

Relationship and Family Level Protective Factors Prevalence of Resilience Among Children with EMB Conditions and 2+ ACEs Exposures by Key Protective Factors. Data: 2011-2012 NSCH

Data: 2007 NHIS and NHIS-Child CAM Supplement and 2008 MEPS Use of Mind–Body Approaches and Mean of Total Conventional Medical Care Expenditures: Children with EMB Conditions and ADD/ADHD. Data: 2007 NHIS and NHIS-Child CAM Supplement and 2008 MEPS Percent estimates and estimated mean of total health care expenditures among mind–body users and nonusers statistically significant at p≤05.